Is Residency More Abusive Than It Needs To Be?

[Strength&Speed]

Although I assume most of you would probably say yes, then why has this system persisted for so long? Do we really need as many calls as we are required to do? Is there a specific benefit to staying up many many nights doing this sort of thing? To me, it really is not beneficial a lot of the time, but abusive. Do you think we could do less call and still retain the same amount of learning?

And I think, honestly, although we have the 80 hr work weeks, it really is not much better. Maybe perhaps at the extremes, where people were working 100+ hr weeks routinely, such as in some surgery residencies, but now it just seems there is more to do in less time.

Is there a reason it needs to continue this way?

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[InGasWeTrust]

If you never been stressed in the middle of the night with a sick patient with supervision/back up how do you expect to do that in Private Practice?

In addition, the more you see and the more you do in general the better doctor you can become if you are motivated....

Put your time in and you will have more opportunities and less stress when you are cut loose to practice independently on the public..

 

[Gern Blansten]

I think one area that people fail to consider is how large a residency program would need to be in order to make call frequency more manageable. If you have a very large residency program in order to allow cush call schedules, then you have some serious issues that arise. Dilution of case experience will become an issue. For instance, if your program has enough craniotomies for the current residents, but none extra, expanding the residency size will mean that you will share the big cases in order to get enough exposure. Nobody wants that. You would also soon have a glut of anesthesiologists on the market, thereby changing market forces and leading to decreased salaries (one would assume).

I personally believe that residency call schedules should be reasonable (ranging from 1 in 4 or 5 to 1 in 6 or 7 depending on rotations and CA level) during residency, but if they are too reasonable (too cush), you may run into a new problem as mentioned above. Besides that, I think there are a lot of cases that you will see at night that you rarely see during the daylight hours(or if the cases show up, you are already assigned elsewhere and you miss it)

BTW S&S, are you a resident? I thought you had previously mentioned you were in the process of applying to med school or were an allied health student. Maybe I have you confused with someone else. Your use of the word "we" confuses me.

 

[2ndyear]

No. Residency is a time for you to learn with a leash on. Get through it, and enjoy making decisions when someone else's full medical license is on the line, not your own. I'd take the ACGME recommendations and multiply them by 3-5 for each case requirement. You need 20 heart pump cases. Is anyone in their right mind going to show up in a practice and do a heart, alone, having done 20 in residency? There is no possible way to get even a taste of cardiac anesthesia from 20 cases. But some programs will slip by having residents get the required ACGME cases and then release them into the real world.

Same thing for pedi. Are you going to let your 4 year old be cared for by an anesthesiologist who did the required 30 1-5 year old anesthetics? I have a different view now that I'm done, but I'm glad I got beat down at times in residency. I'm glad that I stayed late a lot, asked to do the multilevel spinal fusion in the sick kid, did the LVAD trainwrecks, etc.

 

[Strength&Speed]

\GERN.

Gern, I did some residency, but am looking for a change.

 

[Southpaw]

M4 opinion here, so take it with a grain....

You need enough calls to be able to handle, on your own, the large majority if not all problems that a patient could present with. Considering the fact that there seems to be numerous ways to approach anesthesia issues, which requires a ton of practical experience, then I say yes, each and every call provides the potential for benefit to a resident.

We take call as med students, and while it's not even remotely in the same parking lot of the ball stadium of what call is for a resident, I have never perceived call as abuse. I perceive it as the potential to learn and think independently. I do however perceive constant verbal beratement as abuse, but I've only seen that on surgery and even then it was borderline and could have been argued as useful for the resident.

In short, it is my honest opinion that many people going into medicine and graduating from medical school are pansies compared to those of yesteryears. That's just a general feel for things that I've perceived. I'm all for placing priority on family and enjoying life outside of the hospital, but for whatever reason there seems to be a degree of pansiness that comes along with those things that I see in today's medical students (my classmates). Residency is a finite period of time, yeah it's going to suck, you better know that and plan for it going into it. Deal with it. Suck it up, grow a pair. Learn as much as you can during residency, and be the better for it afterwards as an attending.

 

[Gaseous Clay]

Just to re-iterate what others have said, residency is the time to hone our skills and see as much as possible. Since our new CA-1's do not take call the 1st month, I've had the pleasure of taking 9 this month. During a 3 consecutive call stretch, I managed a >10 cm ruptured AAA where EBL was >20 L and I was in there by myself for a good part of the case, an aortic dissection from the root to the iliacs where we went on CPB and circ arrest, and then a 2 month old emergency crani.

At times it is very frustrating, especially when I get home at 9 pm and have to come in the next AM for a 7 AM CABG. But in the end, that type of experience may really benefit me when I'm either by myself or I am THE back-up when the **** hits the fan.

 

[Arch Guillotti]

How in the world can anyone complain about call? Sure we make take a beating all night that is physically exhausting (after having sat cases all day) but good lord when 7 am rolls around you are OUT THE DOOR. No rounding on gomers all morning, no flipping cards or any of that nonsense.

 

[Strength&Speed]

Well, with all the b*tching that goes around, I thought people thought it was more abusive than necessary. Apparently the prevailing opinion is not that it's useless sometimes, but rather just something that needs to be endured. I might disagree some from my own experience, but I appreciate the opinions.

 

[Trisomy13]

How in the world can anyone complain about call? Sure we make take a beating all night that is physically exhausting (after having sat cases all day) but good lord when 7 am rolls around you are OUT THE DOOR. No rounding on gomers all morning, no flipping cards or any of that nonsense.

better yet.. 3p-7a call. I wish I took MORE call .

residency is hard, yes...
abusive? not in my experience, but we tend to have very good relationships with the our attendings, and the surgeons here are tolerable at the least.

 

[Pilot Doc]

No one has mentioned the service aspect of residency. It's a quid pro quo - you provide cheap labor to the hospital and/or attendings and in return you become 1) board eligible and 2)experienced. Some of the unpleasant parts of residency are not for our benefit but exist so that the cost/benefit ratio makes sense for our employers/supervisors.

 

[cchoukal]

No one has mentioned the service aspect of residency. It's a quid pro quo - you provide cheap labor to the hospital and/or attendings and in return you become 1) board eligible and 2)experienced. Some of the unpleasant parts of residency are not for our benefit but exist so that the cost/benefit ratio makes sense for our employers/supervisors.

agree strongly with above post.